Wednesday, January 19, 2011

Million dollar view

Dr.Basto had arranged for me to spend a day at a recently founded private hospital just miles down the road from Hospital São João. I thought it would be an excellent opportunity to see first-hand the differences between the private and public sectors in the Portuguese health system. While I'm no expert in the inner workings of private hospitals in the US, I was nevertheless left nearly speechless after my day.
Hospitalcuf is new private facility opened in June of last year and has since been slowly opening its floors, specialties and services. Funded entirely by private businesses (banks, large corporations, etc), the 90 million dollar project has produced one of the finest, state-of-the-art facilities I have ever seen. With approx 180 beds, 8 ORs, an urgent care center, ICU, and all different types of imaging available at a drop of a dime(…or more), etc, this hospital has it all. To give you a comparison to the public sector, the infirmary ward in Hospital São João may have 4-10 patients per room at anytime. There are two mobile blood pressure /temperature/oximetry readers that the nurses and medical staff fight over every few hours and 5 computers in the doctors’ room (for all 20 residents).  Suffice it to say that resources can be a rate-limiting step. All the while, down the road in Hospitalcuf, there is one patient in one very well-equipped room overlooking the city, spacious private bathrooms, and extremely happy staff.
I imagine that private hospitals in the US are very similar, and I think again about the current trend to cultivate the private health sector in Portugal. Currently, the NHS is in a fragile state—as Dr.Ana Amorim, one administrator of HSJ said, the “budget is not enough, and it’s an unsustainable system.” The population is aging and the workforce is shrinking in a weak economy. Perhaps the private sector, in all its shiny glory is a necessary evil good. I can think of two ways: as a business, healthcare is an extremely profitable sector and can pump money into the fragile economy. Second, it can ease the strain on the public sector by redirecting those who are able to pay private insurance with their more comfortable amenities (not necessarily higher quality medical care). Additionally, Hospitalcuf may act as a competitor to the public healthcare, challenging and examining current standards of practice.
After a tour of the hospital with Dr. Bento Bonafacio, I spent the morning rounding with the internists and the afternoon observing two surgical cases. Their day certainly had a calm and quiet flow—although much of their tranquility can be attributed to the low patient load—the team was only taking care of 3 patients and there were 15 surgical cases (including ambulatory and GI procedures). I wondered if the paucity of patients was due to the recent opening of the hospital or that few people have private insurance. It may be a combination.
So long as public health sector does not get marginalized with the advance of privatized care, the development of this industry may prove quite beneficial and cushion the NHS and the Portuguese economy in the long run…only time will tell, and I wish the new hospital well.

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